1: Comparison of the effect of caffeine and aminophylline on recovery from total intravenous anaesthesia with propofol and fentanyl in laparoscopic hysterectomy: A randomised controlled trial

Abstract

Background and Aims:During extubation, the loss of consciousness (LOC) after general anaesthesia (GA) is reversed by stopping the administration of anaesthetic agents. It is a passive process and it is affected by many factors like age, sex, weight, temperature, duration of surgery, and type of anaesthetic agent used. This study is conducted to find whether caffeine and aminophylline hasten the emergence and reversal of LOC caused by propofol.To evaluate recovery time [time to Bispectral(BIS) index 90] from total intravenous anaesthesia (TIVA) in patients receiving caffeine and aminophylline in comparison to saline/placebo.Methods:This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 to 60 years. The patients were divided into three equal groups (Group C: Caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by random number computer table. The allocation was concealed by the sealed envelope method which was opened after giving GA. GA was induced with propofol, fentanyl, and rocuronium followed by endotracheal intubation and was maintained with propofol infusion. On completion of surgery, infusion of propofol was stopped. The study drug was administered intravenously when a BIS of 60 was achieved. Time to achieve BIS 90, time to the return of regular breathing with adequate tidal volume, to the return of first gag reflex, time to eye-opening on verbal command, handgrip on verbal command, and time to extubation after study drug administration were noted.Haemodynamic and respiratory parameters were also monitored. The Modified Aldrete score was recorded in all patients.Results:The time for BIS 60 to 90 was 10.6±3.9 min in the caffeine group, 12.6± 2.9 min in the aminophylline group, and 24.8 ± 4.8 min in the saline group. Thus, time to recovery was decreased by 57% and 49% in caffeine and aminophylline groups respectively and is statistically significant. The time to return of adequate tidal volume was least in the aminophylline group while it was highest in the control group. The difference was statistically significant when the aminophylline group was compared to the control group while it was insignificant for others. Time to return of gag reflex and time to extubation were statistically significant between aminophylline and saline group, and between caffeine and saline group. Haemodynamic parameters after infusion of the study drug were comparable in all three groups. Modified Aldrete score was higher in both caffeine and aminophylline group than in the control group and the difference was statistically significantTimeGroup S Median (IQR) (min)Group C Median (IQR) (min)Group A Median (IQR) (min) P Return of adequate tidal volume5.0 (3.25)4.0 (2.10)3.8 (2.75)P=0.035Return of gag reflex6.0 (2.85)3.6 (2.6)4.0 (3.5)P=0.005Return of eye opening6 (2.85)5.0 (3.85)4.6 (3.88)P=0.044Return of hand grip6.0 (3.35)4.0 (3.25)5.0 (4.5)P=0.05Extubation time7.0 (2.75)5.5 (3.0)5.0 (3.8)P=0.006Conclusion:Caffeine hastens the recovery from TIVA with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline. The recovery is significantly earlier with either of the drugs compared to when none of the drugs is given